Women with normal glucose tolerance and a history of gestational diabetes show significant impairment of ß-cell function at normal insulin sensitivity.

OBJECTIVE: Although the nature of gestational diabetes mellitus (GDM) remains unclear, the condition is thought to be related primarily to insulin resistance, overweight and obesity. Most studies include women with a history of GDM and later carbohydrate metabolism abnormalities, while reports of women with previous GDM and subsequent normoglycaemia are scarce. The aim of this study was to assess insulin resistance and ß-cell function in normoglycaemic women with a history of GDM. MATERIALS AND METHODS: The study group included 199 women, aged 38.4±6.6 years, diagnosed with GDM within the last 5-12 years [GDM(+)] and a control group of 50 comparable women in whom GDM was excluded [GDM(-)], according to WHO criteria. Blood glucose and insulin levels were measured at the beginning (fasting) and at 60 and 120min of oral glucose tolerance tests. Indices of insulin resistance (HOMA-IR), insulin sensitivity (HOMA-S%) and ß-cell function (HOMA-B%) were calculated. RESULTS: Normoglycaemia was observed in 57% of GDM(+) and 88% of GDM(-) women (P=0.0003). Diabetes was diagnosed in 13 (6.5%) GDM(+) women and in none of the GDM(-) women. Comparison of 113 normoglycaemic GDM(+) and 44 normoglycaemic GDM(-) women revealed significantly impaired ß-cell function (HOMA-B%: 131.1±51.1 vs 144.7±47.1, respectively; P=0.038) with similar normal body mass index (BMI) and no differences in HOMA-IR and HOMA-S%. CONCLUSION: In this study, more than half of the GDM(+) women were presented with normal glucose tolerance. However, despite normoglycaemia, women with a history of GDM were characterized by significantly impaired insulin secretion, but no signs of increased insulin resistance.

Association between the Pro12Ala variant of the peroxisome proliferator-activated receptor-gamma2 gene and increased 24-h diastolic blood pressure in obese patients with type II diabetes.

The aim of the study was to examine an association between the Pro12Ala polymorphism of the peroxisome proliferator-activated receptor (PPAR)-gamma2 gene and blood pressure values assessed by 24-h ambulatory blood pressure monitoring (ABPM) in obese patients with long-lasting type II diabetes. Two hundred and fourteen obese patients (95 men and 119 women) with above 10-year history of type II diabetes were recruited for the study. In all the patients, ABPM was performed and other parameters, including age, body mass index (BMI), waist/hip ratio (WHR), haemoglobin A1c (HbA(1c)), serum lipids and creatinine were also evaluated. The Pro12Ala polymorphism was analysed by polymerase chain reaction-restriction fragment length polymorphism. Two subgroups of patients were compared: (a) Pro/Pro: homozygotic Pro/Pro (n=154) and (b) Ala: Ala allele carriers (Ala/Ala+Ala/Pro) (n=60). The studied groups were not different when age, BMI, WHR, HbA(1c), lipids, creatinine and frequency of hypertension were compared. A similar ratio of patients from both groups were treated with angiotensin-converting enzyme inhibitors, calcium channel blockers, diuretics, beta-blockers and alpha-blockers. A difference was observed in a mean 24-h (Ala: 71.9+/-8.1 vs Pro/Pro: 69.4+/-7.8 mm Hg, P=0.034) and a mean night time (Ala: 67.1+/-7.8 vs Pro/Pro: 64.5+/-8.4 mm Hg, P=0.025) diastolic blood pressure, which was significantly higher in patients with Ala variant. There was also a trend towards a higher mean daytime diastolic blood pressure in this group. It seems that the Pro12Ala variant is associated with an increased mean 24-h diastolic blood pressure in obese diabetic patients. Different reaction for antihypertensive medication depending on a variant of the PPAR-gamma2 gene should also be considered as a possible cause of the presented results.

[Comparisons of laparoscopic and classical adrenalectomy from personal material]. / Porównanie adrenalektomii laparoskopowej i klasycznej w materiale wlasnym.

Postoperative course in 12 patients which had laparoscopic adrenalectomy performed was compared with 8 underwent classic one in terms of operating time, blood loss, blood pressure recordings, C-reactive protein blood concentration, postoperative pain and hospital stay. The advantages of the laparoscopic approach have been stressed.